Effect of Cold Water on Esophageal Motility in Patients With Achalasia and Non-obstructive Dysphagia: A High-resolution Manometry Study

Abstract

Background/aims: Swallowing of cold liquids decreases amplitude and velocity of peristalsis in healthy subjects, using standard manometry. Patients with achalasia and non obstructive dysphagia may have degeneration of sensory neural pathways, affecting motor response to cooling. To elucidate this point, we used high-resolution manometry.

Methods: Fifteen healthy subjects, 15 non-obstructive dysphagia and 15 achalasia patients, after pneumatic dilation, were studied. The 3 groups underwent eight 5 mL single swallows, two 20 mL multiple rapid swallows and 50 mL intraesophageal water infusion (1 mL/sec), using both water at room temperature and cold water, in a randomized order.

Results: In healthy subjects, cold water reduced distal contractile integral in comparison with water at room temperature during single swallows, multiple rapid swallows and intraesophageal infusion (ratio cold/room temperature being 0.67 [95% CI, 0.48-0.85], 0.56 [95% CI, 0.19-0.92] and 0.24 [95% CI, 0.12-0.37], respectively). A similar effect was seen in non-obstructive dysphagia patients (0.68 [95% CI, 0.51-0.84], 0.69 [95% CI, 0.40-0.97] and 0.48 [95% CI, 0.20-0.76], respectively), whereas no changes occurred in achalasia patients (1.06 [95% CI, 0.83-1.29], 1.05 [95% CI, 0.77-1.33] and 1.41 [95% CI, 0.84-2.00], respectively).

Conclusions: Our data suggest impairment of esophageal reflexes induced by cold water in patients with achalasia, but not in those with non obstructive dysphagia.

Keywords: Deglutition disorders; Esophageal achalasia; High-resolution manometry.

Figure 1

Study protocol. All subjects and patients performed 8 single swallows, 2 multiple rapid swallows (MRS) and 1 intraesophageal slow infusion of 50 mL of water, with both cold and room temperature water, administered in randomized order. Furthermore, healthy subjects underwent 200 mL MRS.

Figure 2

Effect of cold water on distal contractile integral (DCI) for single swallow (SS) and 20 mL multiple rapid swallows (MRS), and on 1-minute DCI for 50 mL water infusion in healthy subjects (HS), non-obstructive dysphagia (NOD) and achalasia patients. Data are expressed as ratio between DCI after cold water and DCI after room temperature water. Median and interquartile range are shown.

Figure 3

Effect of cold water on contractile front velocity (CFV) for single swallow (SS) and 20 mL multiple rapid swallows (MRS) in healthy subjects (HS), non-obstructive dysphagia (NOD) (n = 8 after SS and n = 6 after MRS) and achalasia patients (n = 4). Data are expressed as ratio between CFV after cold water and CFV after room temperature water. Median and interquartile range are shown.

Figure 4

Effect of cold water on 4-second integrated relaxation pressure (4s IRP) for single swallow (SS) and 20 mL multiple rapid swallows (MRS) in healthy subjects (HS), non-obstructive dysphagia (NOD) and achalasia patients. Data are expressed as ratio between 4s IRP after cold water and 4s IRP after room temperature water. Median and interquartile range are shown.